Saturday, January 14, 2006

Bad Docs

In last night’s episode, Doc Martin managed to antagonise almost all the townsfolk, and was thought to be uncaring, incompetent, and an all-round nasty person. By the end of the episode, however, everyone is reconciled when they realise that even though he may not be friendly on the outside, he was a professional and a caring person at heart. All they needed was to come to an understanding and accept how each other worked.

While watching the episode, my sympathies (and I suspect those of most doctors who watch the series) were with Doc Martin. I wonder how laymen feel watching him, or for that matter House.

The way I see it, doctors see ‘bad doctors’ as being of the following types:

1. Bad bedside mannersExemplified by Doc Martin and Dr House, or in the local context perhaps that GP who made the news a few years back when it was reported that he had put up a sign outside his clinic stipulating that patients had to adhere to a few rules before they would be seen. Rules like (if memory serves): speak only when a question is put to you, don’t ask too many questions.

I remember thinking that this doctor was ‘weird’, but after a few years in the practice you kind of understand why he might have done that. Not that I would do that myself or advise any doctor to do so, but really I don’t think what he did was ‘wrong’; afterall, in a non-emergency situation, a doctor has the right to decide to end a patient-doctor relationship if there was a ‘serious personality conflict’, and of course the doctor might have reasoned that refusal to adhere to those rules constituted a personality conflict between him and the patient.

I think doctors are usually unwilling to think of another doctor as a bad doctor based on accounts of ‘bad bedside manners’, because we all had that experience of having one patient end the consult with ‘You are such a good doctor and I want to see you the next time I am here.’, and the very next saying ‘I have never seen such a terrible doctor like you and I never want to see you again!’. At the end of the day, the patient-doctor relationship is a relationship between two persons, and as in all relationships, some people click, and some don’t.

2. IncompetentRecently a doctor was reprimanded for failing to diagnose a case of appendicitis in a boy. And that’s not the first time a doctor got into trouble for something like that.

It is of course impossible for most of us to decide if he was indeed incompetent because we do not have all the facts at hand, but again I suspect most doctors will not be too hasty to condemn him.

We all know how difficult it can be sometimes to diagnose an early case of appendicitis (and a great number of other conditions). Sometimes you just can’t tell yet.

That’s why we tell the family to bring the patient back ‘if he gets worse’.

But why would anyone need to be told that? If the patient did get worse, would they really rather take the risk that the doctor might have been wrong, or that the disease had progressed, than to bring the patient for a second consult or a second opinion and be told off because ‘the last doctor already said he was OK’?

I don’t know the answer to that, but I was once rebuffed when trying to tell a mother what signs of appendicitis to look out for in her child with “I do have general knowledge, you know?”

They seem to be the ones that doctors, patients, and the Medical Council are most ready to condemn.

Good.

4. WeirdThe ones that I don’t talk about ‘because it would be gossip’.

While the doctors in the other categories may be considered ‘bad doctors’, it would probably be more appropriate to call these doctors ‘bad co-workers’ or ‘personality disorder cases’. Some of them are actually ‘functional’ as doctors, but you don’t want to go on-call with them.

I guess both Doc Martin and House would be Types 1 + 4.I find that comforting.

4 Comments:

I must say I've hardly met a surgeon who didn't qualify in category 1..and at times category 3 as well...just kidding :0)

If you can't communicate well with your patients, you do not practise good medicine in my opinion. We are trained in the art of unravelling the "difficult historian" for a reason. It's part of the job.

I concur, though, on category 4...I've met many docs who clearly meet DSM criteria for personality disorders who are nonetheless fantastic at their job.

Perhaps medical schools should select FOR medical students with OCD traits :)